The researchers say they found that medications like ramipril, an
angiotensin-converting enzyme ACE inhibitors used to treat high blood pressure
and heart failure, can reduce cardiovascular events but don't seem to influence
the course or development of ED.

"Erectile dysfunction is something that regularly should be addressed in the
medical history of patients," Michael Bohm, MD, lead author of the study and
chairman of internal medicine at the University of Saarland in Germany, says in
a news release. "It might be a symptom of early atherosclerosis."

The study included 1,549 male cardiovascular patients in 13 countries. Each
was asked if he had ED, and men who answered in the affirmative were then
categorized as having mild, mild-to-moderate, moderate, or severe ED. The
average follow-up was five years.

Patients in one trial involving 400 men were randomly assigned to take
ramipril, telmisartan -- an angiotensin II receptor antagonist used to treat
hypertension and heart failure -- or a combination.

In another, ACE inhibitor-intolerant patients were randomly assigned to take
a placebo or telmisartan.

Patients with ED were older and had a higher prevalence of hypertension,
stroke, diabetes, and lower urinary track surgery than men without ED. And 55%
of men had ED when they entered the trials.

Researchers say deaths from all causes occurred in 11.3% of patients who had
ED at the start, but in only 5.6% of people with no ED or only mild problems at
baseline.

They report that 16.2% of ED patients died from cardiovascular problems,
suffered heart attacks or strokes, or were hospitalized for heart failure. Only
10.3% of men with no or mild ED had similar outcomes.

As ED worsened, risk of death from all causes increased, suggesting that ED
identifies men whose cardiovascular disease might be dangerously advanced.

Bohm says that ED is closely associated with conditions that occur in
atherosclerosis and vascular problems, such as plaque buildup, which often
precedes heart attacks and strokes.

"Men with ED going to a general practitioner or a urologist need to be
referred for a cardiology workup to determine existing cardiovascular disease
and proper treatment," Bohm says. "ED is an early predictor of cardiovascular
disease."

Men with ED are often treated for impotence but not underlying cardiovascular
disease, he says, thus placing "a whole segment of men" at increased risk of
death.

Therefore, men and their doctors need to view ED as a risk factor, just as
they do high blood pressure and cholesterol, he says.

The study is published in the March 15 issue of Circulation: Journal of the
American Heart Association.